Abstract
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the brain, caused by reactivation of the polyomavirus JC (JCV). PML has classically been described in individuals with profound cellular immunosuppression such as patients with AIDS, hematological malignancies, organ transplant recipients or those treated with immunosuppressive or immunomodulatory medications. The occurrence of PML in patients without identifiable immunodeficiency represents a therapeutic challenge. Tumor-induced immune suppression is a fundamental problem in cancer biology. We present a case of 71-year-old man with bladder cancer. The patient was diagnosed with PML after an epileptic seizure followed by a coma. MRI images were compatible with PML. Presence of JC virus in the cerebrospinal fluid confirmed the diagnosis. Unfortunately the patient died shortly after the diagnosis. There is no specific treatment for JCV. The reconstitution of the immune system seems the most effective approach.
Highlights
Progressive multifocal leukoencephalopathy (PML) is a rare, progressive and lethaldemyelinating disease of the brain, causing irreversible neurological damages [1]
PML has classically been described in individuals with profound cellular immunosuppression such as patients with acquired immune deficiency syndrome (AIDS) - 82%, hematological malignancies - 8%, organ transplant recipients - 3%, rheumatology pathologies - 0.44% or patients with autoimmune disease under immunosuppressive or immunomodulatory treatment [2]
PML is caused by the JC virus which belongs to the type Polyomavirus, of the family of Papovariridae [4].The viral particles, causing the illness, in oligodendrocytes have been identified in 1965
Summary
Progressive multifocal leukoencephalopathy (PML) is a rare, progressive and lethaldemyelinating disease of the brain, causing irreversible neurological damages [1]. It is caused by the John Cunningham virus (JCV), a Polyomavirus, responsible for the destruction of oligodendrocytes. The general status of the patient excluded further systemic treatment with cisplatin based chemotherapy regimen. Pyrexia due to underlying pneumonia and simultaneous urinary infection He was hospitalized in the intensive care unit and received adequate antibiotic therapy and hydration. His general status was marked by a progressive loss of consciousness leading to a coma.
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